Healthcare Consultant I

Location: Work from Home. Candidate must reside in Miami Dade county
Training will be conducted remotely via Microsoft Teams.
Candidate will travel approximately 75% of the time within the region seeing
Members at home, in assisted living facilities and nursing homes.
Preferred Qualifications:
Bilingual Spanish/English (required)
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Effective communication skills, both verbal and written

• Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
• Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
• Conducts comprehensive evaluation of Members using care management tools and information/data review.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Conducts multidisciplinary review to achieve optimal outcomes
• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgeably participate with their provider in healthcare decision-making.
• Monitoring, Evaluation and Documentation of Care:
  Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.